Medicare Miracle?

More Krugman on good health care news...Medicare is, perhaps not a "miracle," but in very good shape compared to the dire predictions of crank "deficit scolds" (who routinely used the worst Medicare predictions moving forward primarily to deflect from the the issue of health care cost inflation to attack any and all government spending - except of course defense):

So, what do you think about those Medicare numbers? What, you haven’t heard about them? Well, they haven’t been front-page news. But something remarkable has been happening on the health-spending front, and it should (but probably won’t) transform a lot of our political debate. 

The story so far: We’ve all seen projections of giant federal deficits over the next few decades, and there’s a whole industry devoted to issuing dire warnings about the budget and demanding cuts in Socialsecuritymedicareandmedicaid. Policy wonks have long known, however, that there’s no such program, and that health care, rather than retirement, was driving those scary projections. Why? Because, historically, health spending has grown much faster than G.D.P., and it was assumed that this trend would continue. 

But a funny thing has happened: Health spending has slowed sharply, and it’s already well below projections made just a few years ago. The falloff has been especially pronounced in Medicare, which is spending $1,000 less per beneficiary than the Congressional Budget Office projected just four years ago. 

This is a really big deal, in at least three ways.

"Washington is still stuck in the wrong conversation"

Ryan Cooper @ WaPo Plumline explains how the Beltway is still stuck on Stupid...or worse:

With the shutdown and debt ceiling crisis over and budget negotiations beginning, it’s worth noting that we’re stuck back in the same old rut we’ve been stuck in since Republicans took the House in 2010. Republicans want cuts to social insurance, or say they do, and Democrats want a bit of new tax revenue in return. On a policy level, this is nuts. We’re trading austerity for…more austerity. Democrats and Republicans ought to consider bringing in other ideas. Almost anything else would be better.

"Republicans are delusional about US spending and deficits"

Dean Baker @ The Guardian:

It is understandable that the public is disgusted with Washington; they have every right to be. At a time when the country continues to suffer from the worst patch of unemployment since the Great Depression, the government is shut down over concerns about the budget deficit.

There is no doubt that the Republicans deserve the blame for the shutdown and the risk of debt default. They decided that it was worth shutting down the government and risking default in order stop Obamacare. That is what they said as loudly and as clearly as possible in the days and weeks leading up to the shutdown. In fact, this is what Senator Ted Cruz said for 21 straight hours on the floor of the US Senate.

Going to the wall for something that is incredibly important is a reasonable tactic. However, the public apparently did not agree with the Republicans. Polls show that they overwhelmingly oppose their tactic of shutting down the government and risking default over Obamacare. As a result, the Republicans are now claiming that the dispute is actually over spending.

Anywhere outside of Washington DC and totalitarian states, you don't get to rewrite history. However, given the national media's concept of impartiality, they now feel an obligation to accept that the Republicans' claim that this is a dispute over spending levels.

But that is only the beginning of the reason that people should detest budget reporters. The more important reason is that they have spread incredible nonsense about the deficit and spending problems facing the country, causing most of the public to be completely confused on these issues. If budget reporters were held to the same standards as school teachers, with the expectation that they would be able to convey information, they would all be fired in a minute.

Contrary to the widely repeated stories of out-of-control deficits and spending, deficits have plunged in the last four years falling from 10.1% of GDP in 2009 to just 4% of GDP in 2013. The Congressional Budget Office projects the deficit to be just 3.4% of GDP in 2014. The latest projections show the debt-to-GDP ratio falling for the rest of the decade.

U.S. Health Care Spending...Again

The world's least cost-effective health care system. Shirley Wang @ WSJ:

That the U.S spends a lot of money on health care is a refrain many Americans are familiar with, but the latest health expenditure data from the Organization for Economic Co-operation and Development still are striking. Here’s a graph of health-care expenditure as a percentage of gross domestic product for the 34 member nations of the OECD between 1980 and 2012. As you can see, there’s one country whose expenditure begins to distinguish itself from all the others — the U.S.

In 2011, the most recent year in which most of the countries reported data, the U.S. spent 17.7% of its GDP on health care, whereas none of the other countries tracked by the OECD reported more than 11.9%. And there’s a debate about just how well the American health-care system works. As the Journal reported recently, Americans are living longer but not necessarily healthier .

On the lack of serious discussion or an honest opposition

Professor Krugman channels the outrage at alleged GOP "policy wonks" who are little more than ethically-challenged propagandists:

I fairly often receive mail pleading with me to take a more even tone, to have a respectful discussion with people on the other side rather than calling them fools and knaves. And you know, I do when I can. But the truth is that on most of the big issues confronting us, there just isn’t anyone to have a serious discussion with. Ezra Klein offers a nice illustration of this point today, in his takedown of Avik Roy on Obamacare in California.

The thing you want to bear in mind is that Roy is widely considered a good example of a reformist conservative, not to mention a health policy wonk. So what does this reform-minded wonk have to say about Obamacare?

Klein tries really hard to keep his temper even; too hard, I think, because I wonder how many readers will stay with him all the way through. But to cut to the chase, Roy claims that Obamacare will cause soaring insurance rates, using a comparison that is completely fraudulent — and I say fraudulent, not wrong, because he is indeed enough of a policy wonk here to know that he is pulling a fast one.

"The Sequestering of Barack Obama"

Robert Kuttner @ The American Prospect takes a hard look at the economics and politics of the sequester in the context of President Obama's overall strategic and substantive performance on the economy - a sobering critique:

President Obama has miscalculated both the tactical politics of the sequester and the depressive economic impact of budget cuts on the rest of his presidency. The sequester will cut economic growth in half this year. But it’s now clear, one way or another, that we will get cuts in the $85 billion range that the sequester mandates this fiscal year. All that remains are the details.

Obama’s miscalculation began in his fist term, with his embrace of the premise that substantial deficit cutting was both politically expected and economically necessary, and his appointment of the 2010 Bowles-Simpson Commission as the expression of that mistaken philosophy. Although the Commission’s plan was never carried out, its prestige and Obama’s parentage of it locked the president into a deflationary deficit reduction path.

This past week, we’ve seen how the Republicans took advantage of Obama’s self-inflicted wound. With the March 1 deadline looming, the White House assumed that if the president gave enough publicity to the harm of pending automatic cuts, the Republicans would just cave. But the Republican leadership calculated that the ensuing political and economic damage would be worse for Obama, so they hung tough.

Obama also assumed that military cuts would be enough to move Republicans to  compromise. But with two wars winding down, most Republicans decided that this year they were deficit hawks more than defense hawks.

The president also played the populist card, calling for tax increase on the wealthy to spare the rest of the country program cuts. But that didn’t move the Republicans either.

The Republican leadership also deftly evaded the risk of being blamed for shutting down the government. They offered the Democrats a continuing resolution to allow government to keep operating, but at $85 billion below current spending levels. That shifted the onus to Democrats if they refused to take the deal and Congressional leaders advised the president that they were not prepared to take that risk.

Finally, Republicans took some of the sting—and responsibility—out of the sequester by offering to give Obama new flexibility in how he implemented it, thus making it even more his problem.

Next to come is the long awaited grand bargain of the austerity lobby, in which Republicans agree to close some tax loopholes (which start out grotesquely swollen) and Democrats agree to breach the previously sacrosanct fortresses of Social Security and Medicare.

On all counts, advantage: Republicans.

Long term, colluding in the politics of budget austerity has left Obama with no real capacity to offer the public investment that the economy needs for a robust, broadly-based recovery, and leaves him with the prospect of a weak economy between now and the end of his term--unless he drastically shifts course and repudiates the entire view of the budget and the economy.

Joe Scarborough is an idiot

 Jon Chait @ New York magazine makes the case:

The deficit scold cause has suffered significant intellectual erosion over the last year or so. In the short run, the interest rate spike they keep insisting will happen keeps not happening. In the long run, the health-care-cost inflation that is at the root of the long-term fiscal predicament is growing markedly less dire. The case for prudent fiscal adjustment remains strong, but the case for  bug-eyed, table-pounding terror is growing increasingly ridiculous.

But bug-eyed, table-pounding terror is the stock-in-trade of the fiscal scold movement. And so they are striking back by labeling anybody with a calmer view of the deficit as a “debt denier.” Joe Scarborough, who may have launched the new catchphrase on Twitter, has a new op-ed in Politico brandishing the epithet. Meanwhile, the anti-deficit lobby “Fix the Debt” — for whom Scarborough has served as one of many media spokespersons — has taken up Scarborough’s favorite label with a new campaign, debtdeiners.com, which, alongside its latest attempt to generate a viral dance video, amounts to a concerted counteroffensive against Paul Krugman and others who have ever so slightly mitigated the tone of apocalyptic hysteria surrounding the fiscal debate. They even have their own debt deniers hashtag. They are trying very hard to make “debt deniers” happen.

Let’s examine their case on the merits, not merely as an attempt to create a viral meme.

Analyzing the argument in a Joe Scarborough–authored op-ed is inherently challenging. (The written word in general is just a terrible medium for Scarborough, hiding his winning personality while exposing his inaptitude for analysis.) It mainly consists of using variations of “debt denier” repeatedly to describe his opponents. To his credit, Scarborough finally cites one actual economist who shares his view, a welcome departure from his usual method of answering charges that he is in the grips of an incestuous groupthink driven by non-economist elites by citing the agreement of his non-economist elite friends.

"CBO's Scary Debt Chart Not Looking Very Scary These Days"

Kevin Drum @ Mother Jones:

The CBO's latest budget projections are out today. Here's the scary debt chart:


Hmmm. Not so scary after all. The CBO's projections are, of course, sensitive to both their economic forecasts and their reliance on current law. However, their economic forecast seems fairly conservative, and current law is a lot more reliable now than it was before we decided what to do about the Bush tax cuts. So CBO's projections are probably fairly reasonable.

You can decide for yourself, of course, whether you find this debt projection scary even though it's flat for the next decade. Maybe you think it needs to decline to give us more headroom for the future. Maybe you think it masks the problem of growing debt after 2023. Maybe you think we're likely to have another recession over the next decade, which will balloon the debt yet again.

"Why the US government never, ever has to pay back all it's debt"

Mathew O'Brien @ The Atlantic counters the deficit hysteria:

How will our children, grandchildren, and sundry other friends and relatives too young to see an R-rated movie unaccompanied ever pay back the entire debt the government is piling up now? Easy. They won't. The U.S. government is never completely debt-free (except for that one time it sold land seized from Native Americans).

There's only one thing you need to know about the government. It's not a household. The government, unlike us, doesn't need to pay back its debts before it dies, because it doesn't die (barring secession or a sneak attack from across the world's longest unprotected border -- a most unworthwhile initiative). In other words, the government can just roll over its debts in perpetuity. That's the point Michael Kinsley misses when he says we "can't borrow forever," in an otherwise fine column trying to convince unemployment and deficit hawks that they actually agree on a "barbell" approach -- stimulus now, austerity later -- to fiscal policy. We can, and in fact have, borrowed forever. And that doesn't mean our debt burden will go up forever either. As you can see in the chart below, the government dramatically decreased its debt-to-GDP ratio in the three decades following World War II, despite mostly running deficits during the time. 

(Note: This chart shows gross debt, which includes debt the government owes to itself, such as the Social Security trust fund. Debt-to-GDP is on the left axis; deficit-or-surplus-to-GDP on the right).

Here's the budget math. Between 1946 and 1974, debt-to-GDP fell from 121 to 32 percent, even though the government only ran surpluses in eight of those years (and the surpluses were generally much smaller than the deficits). That's because nominal GDP -- just the cash size of the economy -- grew much faster than debt did. As Greg Ip of The Economist points out, fast nominal GDP growth, and the easy monetary policy that requires, is the only way governments have ever successfully reduced debt ratios in the past. Austerity alone will fail. (See Europe).

Okay, so maybe endless debt and deficits aren't a problem, but won't bond markets go Galt on us if we don't start to get our fiscal house in order? And even if the bond vigilantes turn out to be more like Godot, won't ever-increasing debt lead to ever-decreasing growth?

Exception to the rule - "A Conservative Case for the Welfare State"

Authentically conservative and eminently sensible policy wonk Bruce Bartlett - a former advisor to Reagan, GHW Bush,  Jack Kemp and Ron Paul - combats The GOP Crazy:

At the root of much of the dispute between Democrats and Republicans over the so-called fiscal cliff is a deep disagreement over the welfare state. Republicans continue to fight a long-running war against Social Security, Medicare, Medicaid and many other social-welfare programs that most Americans support overwhelmingly and oppose cutting.

The bottom line on the central spending issue facing the US

Republicans in Congress opposed the New Deal and the Great Society, but Republican presidents from Dwight D. Eisenhower through George H.W. Bush accepted the legitimacy of the welfare state and sought to manage it properly and fund it adequately. When Republicans regained control of Congress in 1994 they nevertheless sought to repeal the New Deal and Great Society programs they had always opposed.

Energized by their success in abolishing the principal federal welfare program, Aid to Families With Dependent Children, in 1996, Republicans tried to abolish Social Security as well, through partial privatization during the George W. Bush administration, and they more recently have attempted to change Medicaid into a block grant program with funds going to the states and to turn Medicare into a voucher program.

In the 40th anniversary edition of his book, “Capitalism and Freedom,” Milton Friedman advised conservatives to use crises as opportunities to advance their agenda. “Only a crisis – actual or perceived – produces real change,” he contended.

Thus Republicans are now using the fiscal impasse to try to raise the age for Medicare and reduce Social Security benefits by changing the index used to adjust them for inflation. They know that such programs will be easier to abolish in the future if the number of people who qualify can be reduced and benefits are cut so that privatization becomes more attractive.

This is foolish and reactionary. Moreover, there are sound reasons why a conservative would support a welfare state. Historically, it has been conservatives like the 19th century chancellor of Germany, Otto von Bismarck, who established the welfare state in Europe. They did so because masses of poor people create social instability and become breeding grounds for radical movements.

"Medicare spending isn't out of control"

While there is agreement among economists and health care experts that overall the US has highly inflationary health care expenses over the long term - certainly compared to other relatively wealthy countries with high-quality medical care and much better health outcomes - Uwe E. Reinhardt @ New York Times Economix shows, once again, that the locus of this "out of control" spending isn't Medicare:

It’s the season of holiday cocktail parties, demanding intelligent chit-chat over Chardonnay. In such data-free environments it is always safe to say, “Medicare spending is out of control!” Wise heads will nod, because it is a credo with wide currency.

After all, as I explained in my previous post, traditional Medicare, which still attracts about 75 percent of all Medicare beneficiaries, affords its enrollees free choice of providers and therapy. In the jargon of health-policy wonks, it is “unmanaged.” Thus, it would not be surprising if unmanaged Medicare spending were, indeed, out of control.

But some caution is in order. A really wise guy in the crowd, one familiar with relevant data, might challenge you with: “Oh, really? In what sense is Medicare spending out of control?”

That query might have been prompted by the following data.

 

Kaiser Family Foundation

These data, most of which have been published by the Office of the Actuary, Centers of Medicare and Medicaid Services, of the Department of Health and Human Services (see Table 16), show that in most periods Medicare spending per Medicare beneficiary has risen more slowly than per-capita spending under private health insurance.

The exceptions are the period 1993-97, when private managed-care plans appeared to be able to hold down their outlays on health care better than did Medicare, and 2002-7, because there was a jump in spending as Medicare began, in 2006, to cover prescription drugs under the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

So anyone claiming that “Medicare spending is out of control” can fairly be asked to explain on what data that assertion is based. The responses might be interesting.

Two objections might be raised to my interpretation of the data.

Cliff notes...

Laura D'Andrea Tyson @ New York Times:

...The economy continues to operate far below its capacity. The unemployment rate is at least two percentage points higher than what most economists consider consistent with a full recovery. Other measures, such as the high rate of long-term unemployment and the low labor-force participation rate, reflect an impaired labor market.

According to the Congressional Budget Office, gross domestic product is still about 6 percent, or about $973 billion, below the potential level the economy is capable of producing at full capacity. This is the largest gap between actual and potential output following a recession in modern American history.

The weakness of government spending at the state and local level and more recently at the federal level has been a significant factor behind the slow recovery. The phasing out of earlier federal stimulus measures, the expiration of temporary payroll-tax relief and extended unemployment benefits scheduled at the end of the year, and the tight caps on discretionary federal spending already in force mean more federal fiscal drag on the economy’s growth next year even if the fiscal cliff is averted...

Zombies "at the table"

Lots of talk about what's "on the table" in "fiscal cliff" negotiations. Krugman, again, clarifies what's at stake and what "zombie ideas" are just stupid. Let's keep the zombies away from "the table":

America’s political landscape is infested with many zombie ideas — beliefs about policy that have been repeatedly refuted with evidence and analysis but refuse to die. The most prominent zombie is the insistence that low taxes on rich people are the key to prosperity. But there are others. 

Undead?

And right now the most dangerous zombie is probably the claim that rising life expectancy justifies a rise in both the Social Security retirement age and the age of eligibility for Medicare. Even some Democrats — including, according to reports, the president — have seemed susceptible to this argument. But it’s a cruel, foolish idea — cruel in the case of Social Security, foolish in the case of Medicare — and we shouldn’t let it eat our brains. 

First of all, you need to understand that while life expectancy at birth has gone up a lot, that’s not relevant to this issue; what matters is life expectancy for those at or near retirement age. When, to take one example, Alan Simpson — the co-chairman of President Obama’s deficit commission — declared that Social Security was “never intended as a retirement program” because life expectancy when it was founded was only 63, he was displaying his ignorance. Even in 1940, Americans who made it to age 65 generally had many years left. 

Deficits - Don't believe the "Mediscare" hype. The issue is systemic healthcare costs, which are driven by private markets.

Ezra Klein:

From the Congressional Budget Office’s hot new white paper, “Options for Deficit Reduction“:

That’s all of the federal government’s spending in three graphs. The top graph is health care, including Medicare, Medicaid and the Affordable Care Act. The middle graph is Social Security. And then there’s literally everything else: Defense, education, infrastructure, food safety, R&D, farm subsidies, the FBI, etc.

What these three charts tell you is simple: It’s all about health care. Spending on Social Security is expected to rise, but not particularly quickly. Spending on everything else is actually falling. It’s health care that contains most all of our future deficit problems. And the situation is even worse than it looks on this graph: Private health spending is racing upwards even faster than public health spending, so the problem the federal government is showing in its budget projections is mirrored on the budgets of every family and business that purchases health insurance...

Got that?  Private health care costs are inflating faster than government health care spending.  Which means it's not a "Medicare" problem.  The issue we need to attack is getting systemic health care costs under control. When you hear anyone blame Medicare as the root of our budget problems or their target in "getting health care costs under control", they are either selling you their ideology or their ignorance.  The prevalence of this nonsense is a key to understanding why as a nation our health care spending per capita is about twice as much as the high-quality universal systems such as France and Canada, with no better outcomes to show for it.

Remember, when "Morning Joe" et. al. blame Medicare for out-of-control costs, you are listening to people spreading ignorance

CBPP:

Cutting Medicare and Medicaid is a sure path to INCREASING the percentage of GDP the county spends on health care.  Most of the discussion about "entitlements" burdening our economy are based on utter disinformation or near-total ignorance.  Replacing Medicare with vouchers - or even raising the eligibility age - will explode health care costs.  Not just out-of-pocket for seniors, but in aggregate.

The "cure" of cutting Medicare and Medicaid can only mean one of two things - exploding health care costs as private insurers pick up market share and hospitals are burdened with the uninsured flooding emergency rooms, or people simply going without essential health care. 

There is definitely a need to control health care inflation in relation to our overall economy, but privatization via vouchers or raising the Medicare age take us in exactly the wrong direction, as the chart shows. Medicare and Medicaid do the best job of cost-control, compared to private insurance.

Although Mitt Romney is as credible as a used-car salesman, there's at least one thing that we know is at stake Nov. 6

Mitt Romney has proven himself the "Etch-a-Sketch" candidate on any and every issue, but James Suroweicki @ The New Yorker explains at least one thing we can count on if this slippery character manages to hedge and edge his way into the White House:

Mitt Romney can be a hard man to pin down. But there is one thing that he’s been clear about: if he becomes President, he will repeal Obamacare. That simple promise, more than any other that Romney has made, illuminates what is most at stake in this year’s election. The campaigns may spend most of their time talking about taxes and jobs. But health care is where the election’s outcome will have the most immediate and powerful impact on how Americans live. 

Romney's got you covered

Steve Benen @ Maddowblog

Just three weeks ago, CBS's Scott Pelley asked Mitt Romney, "Does the government have a responsibility to provide health care to the 50 million Americans who don't have it today?" The Republican didn't answer the question directly, but instead suggested there's no cause for alarm -- the uninsured can rely on emergency rooms.

The exchange was widely panned for being both callous and ignorant, and yet, as Rebecca Leber noted, Romney apparently can't help himself.

"We don't have a setting across this country where if you don't have insurance, we just say to you, 'Tough luck, you're going to die when you have your heart attack,'  " he said as he offered more hints as to what he would put in place of "Obamacare," which he has pledged to repeal.

"No, you go to the hospital, you get treated, you get care, and it's paid for, either by charity, the government or by the hospital. We don't have people that become ill, who die in their apartment because they don't have insurance."
He pointed out that federal law requires hospitals to treat those without health insurance -- although hospital officials frequently say that drives up health-care costs.

The Madness...

Think Progress:

The Choice

Via Daily Kos:

President Obama in Dubuque, Iowa, returning fire on Medicare in the wake of the Romney-Ryan campaign's new "Mediscare" attack ad:

"I think they know their plan is not very popular," the president said. "You can tell that because they're being pretty dishonest about my plan." 

"Here's what you need to know," the president continued. "I have made reforms that have saved millions of seniors with Medicare hundreds of dollars on their prescription drugs." Obama was referencing the fact that Obamacare closed the donut hole, which Romney and Ryan would reinstate. "I have proposed reforms that will save Medicare money by getting rid of wasteful spending in the system. Reforms that will not touch your Medicare benefits, not by a dime."

As for Romney and Ryan? "They have a very different plan," the president said. "They want to turn Medicare into a voucher program." That would end the guarantee of Medicare, Obama said, citing the CBO study showing that the Ryan plan would cost seniors an extra $6,400 per year.

"My plan has already extended Medicare by a decade. Their plan ends Medicare as we know it. My plan reduces the cost of Medicare by cracking down fraud, and waste, and subsidies to insurance companies. Their plan makes seniors pay more so they can give another tax cut to millionaires and billionaires. That's the difference between our plans on Medicare, that's an example of the choice in this election.."

All you need to know about Paul Ryan

Aside from his fealty to the sociopathic cult novelist Ayn Rand (she of the "Christian morality is evil" Objectivist  philosophy that was embedded in a series of melodramatic  novels), the following is IMHO the single most salient fact attached to Paul Ryan:

(B)ecause commercial insurers cost more to run than government plans, the Wisconsin Republican's proposal to privatize Medicare starting in 2022 would actually spark a dramatic increase in how much the nation spends on healthcare for the elderly, according to an independent analysis by the nonpartisan Congressional Budget Office.

There is not an ounce of "fiscal conservative" in this scheme - it's privatization for the sake of ideology - Ayn Rand's "moral foundation" for unbridled capitalism of the sort that makes sociopaths and parasites like Dick Cheney and Mitt Romney multi-millionaires many times over.